- Enrollment id
- O20231218002731
- Enrollment state
- OH
- Provider type code
- 00-04
- Provider type text
- PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Npi
- 1255022067
- Multiple npi flag
- N
- Ccn
- D21027
- Associate id
- 5698762235
- Organization name
- FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.
- Incorporation date
- 1973-01-16
- Incorporation state
- OH
- Organization type structure
- OTHER
- Organization other type text
- 501 (C)(3) CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 600 E. CANAL ST./PO BOX 279
- City
- ANSONIA
- State
- OH
- Zip code
- 453030279
- Telephone number
- 9373375141